ABSTRACT
Professor Michael Peckham was appointed as the first National Health Service (NHS) Director of Research and Development in 1990. The initial phases of the 'Peckham revolution' can be seen as addressed to the funders, managers and 'doers' of R&D, albeit with a clear acknowledgement of the centrality of effectively disseminating the products of research. The advent of the R&D strategy has prompted consideration of the relationship between a number of hitherto diverse and previously apparently hermetically sealed elements of NHS endeavour and activity, namely: research and development; clinical audit; clinical effectiveness and the consequent notion of evidence-based medicine or 'knowing what there is to know'. Framework for Appropriate Care Throughout Sheffield (FACTS) project was stimulated by the acknowledgement that the perceived independence and idiosyncrasy of general practioners implies that managing changes in their behaviour presents the greatest challenge in a health care world full of challenging professional behaviours.
